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ea <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, Will 54872 Office of Zoning Administrator "5 o <br /> APPLICATION FOR — LAND USE — PERMITS - <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Qe' <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. m <br /> c 0 <br /> � C Q <br /> TELEPHONE / .�(`�Ld o F <br /> f�,� 7 O A <br /> ADDRESu�"�/ ��� v�.� rT i r�r �P 1 A) `CSD 37 0 <br /> 77�� //�l �r 1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> , <br /> LEGAL DESCRIPTION (see tau receipt) I CSAR 110/umC /� /,.2ZCY[5 2Y- 3 i� �r. /a/s 4y!7 <br /> CONTRACTOR I sC0 ..Js s^ .27 •37 Ni Rr� &W. <br /> s <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-20-�-W GARAGE/ACCESSORY <br /> E/ACCCC <br /> ESSORY STRUCTURE ADDITION p <br /> n Q <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION oLip <br /> 0 <br /> )� � a <br /> STRUCTURE/ADDITION USE:GV�� me am /n/d///-Ou�- / ,Slmi..� w/Wra�Q-QrOu-..-d rj[ o- ° <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.)-A95,91 102vAp Z o O., <br /> 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> 2. Show the location of the well (W),septic tank (ST), and drainf laid (DF). <br /> 3. Show dimensions In feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordinary high water mark of lake, stream,or river. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1A 3 <br /> PLOT PLANc <br /> '�- <br /> bjel( I5n <br /> ni <br /> / N <br /> 0 <br /> r-j <br /> y UJ <br /> 10-0- <br /> A <br /> I- 1 <br /> 5 Te �t c�ec� A\\ n <br /> A �, (d. <br /> n� L 'y f <br /> CONDITIONS OF PERMIT: o 2'' Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. , m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. X <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- �+ ; m <br /> lion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- a ? $ ; m <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I p $ $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have ' <br /> access to the above des less at any reasionableoTe for the purpose of inspection. <br /> T is <br /> SIGN HERE <br /> M: <br /> (signature of owner o 9 ng contractor) I D mal <br /> ZONING ADMINISTRATOR I' '• g E i <br /> WWI I <br /> TOWNSHIP PERMITS MAY BE REOUIRED , o T <br /> 4 !S{> m <br /> rn <br /> - `8888881 (n <br /> lrl�� n7 �a-»-9y <br />